When women discover lumps in their breasts, the usual reaction is to panic and worry about undergoing invasive surgery.We are here to guide women through this difficult time and make sure that they are fully informed about how to proceed. There are many new technologies which have been introduced to the world of breast cancer treatment, each method with its own specific advantages and disadvantages. Not all women with breast cancer receives the same treatment. Doctors consider a woman’s specific medical conditions and the patient’s preferences. Breast cancer treatments can be divided into five major procedures: Surgery, Radiation therapy, Chemotherapy, Hormone therapy, and Targeted therapy.
Dr. Voratape Kijtavee explains how the The Intact™ Breast Lesion Excision System and VACNB use the same technique. In both procedures, a biopsy needle is inserted through the small incision in the skin and is guided by ultrasound in obtaining a tissue sample. Both methods are used for diagnostics and treatment, allowing for suspicious breast lumps to be detected, removed and evaluated by the doctors.
With this method, a round tissue sample is obtained. The first advantage of this method is that it is a simple technique that requires a small incision. Another advantage is one can receive treatment alongside the biopsy, as the suspicious lump and surrounding tissue can be removed using the same technique as cancer-removing surgery.
For this procedure to be performed, the breast tumor should not be larger than 1.5 cm. The device can remove lumps of up to 2 cm but, because the procedure also requires for the surrounding tissue to be removed by the doctor, the tumor should not be larger than 1.5 cm. The drawback to this procedure is that it cannot be performed if the lump is too close to the skin of the breast or muscle in the chest wall.
With this method, strips of tissue are tested. A biopsy needle is inserted into the lump and, with the aid of a vacuum-powered instrument, several tissue samples can be taken. The vacuum draws tissue into the needle and a rotating cutting device takes the samples in a simple, convenient manner. This method has the advantage of being able to remove multiple lumps while leaving small incisions.
With these medical technologies, both small and large lumps can be easily removed without the need to undergo surgery.
Many women do not take the precaution of scheduling regular health check-ups for abnormality detection. Women who receive regular health check-ups are able to have their cancer detected at an early stage or in stage 0. During stage 0, abnormal cells are found in the lining of the breast milk duct before they have spread to normal tissue. In this stage, the breast cancer can be 100% cured and breast removal is unnecessary, discusses Dr. Shinawatt Visutdiphat. The method that can be used is called breast conserving surgery.
Although breast conserving surgery has been performed for over 20 years, the misconception remains that the entire breast must be removed to prevent the risk of the cancer returning in that breast. Breast conserving surgery is not complicated. Without reconstruction, breast conserving surgery is less time consuming, more minimally invasive and with fewer complications and anesthetic risks than entire breast removal.
Breast conserving surgery and a mastectomy provide a similar outcome. The most important difference, however, is that breast conserving surgery must be combined with radiotherapy. Cancer is considered a tissue organization problem. Breast conserving surgery must be followed by radiotherapy, so as to destroy the abnormal cells completely and prevent the cancer from returning. Radiotherapy should be delivered to the whole breast in 25-33 daily sessions lasting about 15 minutes each.
Some people mistakenly assume that radiotherapy after breast conserving surgery is time consuming and painful. Thinking so, they decide to have their entire breasts removed rather than undergo the treatment. However, the latest development in radiotherapy machines result in fewer risks of complications and less pain. Some patients report feeling no pain at all. Do not let unfounded fear make such an important decision for you, because you may regret it later in life.
Chemotherapy is an intensive drug treatment which destroys cancer cells and prevents them from dividing and multiplying. This method also eases some of the physiological cancer symptoms, such as pain or pressure caused by tumors. Chemotherapy is often used in tandem with radiation or post surgery to further the healing process. Chemotherapy can be given through injections into the muscles, given directly into the arteries of the affected area, given intravenously, given directly to the organs affected, or through pills or topical cream. Nausea, loss of hair, and fatigue are the most common side effects of chemotherapy.
Hormone therapy is most used after surgery to prevent cancer from returning. Estrogen promotes the growth of cancers that are hormone receptor-positive. Because 2 out of 3 breast cancers are hormone receptor-positive, blocking estrogen becomes an important component in pre-emptive treatment. Medication usually takes pill form or through hormone injections, either blocking or lowering estrogen levels.
Cancer treatment by radiation is using high-energy rays to destroy cancer cells. Radiation therapy is often used after breast conserving surgery to prevent the cancer from resurfacing in the lymph nodes and breast. For other patients, such as those who undergo a mastectomy, radiation therapy is performed when the cancer is discovered in the lymph nodes or when the cancer is larger than 5 centimeter. Patients can receive radiation therapy both externally (external beam radiation) or internally (brachytherapy). Other than breast cancer, radiation is also used to treat cancer in other areas of the body, such as in the brain or in the bones.
Targeted therapy uses medicine to treat breast cancer by specifically targeting cancer cells, preventing them from growing and spreading. The drugs used during this type of therapy often have less severe and different side effects to chemotherapy drugs. The targeted therapy drugs are divided into two categories – drugs that target the HER2/neu protein (growth-promoting protein which makes cancer spread more) and drugs that help hormone therapy work better. In addition to breast cancer, targeted therapy is also used to treat other types of cancer, such as lung cancer, liver cancer and colon cancer.
*This article contains information translated from original articles published by Samitivej Hospital on July 7, 2014 and June 19,2012.
Diploma of Thai Board of General Surgery, 1998 , 1998
M.D., Faculty of Medicine, Mahidol University
M.D., Faculty of Medicine, Khon Kaen University, 2005.